| Off the Couch |

Back to the Trenches

"I’m not sure I want to go back there, even on the other side"

 

Imet Kalman for the second time at a mosad that was a cross between a yeshivah and a rehab center, where he was a dorm counselor and had obviously developed a strong rapport with the bochurim. They called him their shrink. Part III

Kalman was about to start the final year of his degree in social work, when he called and asked if we could meet.

For Kalman, it was a milestone. Before he started, he was nervous about entering a rigorous academic program, considering his own less-than-stellar early yeshivah history — but now he was heading toward the finish line. We’d remained in touch since he made a decision to put his natural talents and hard-won personal victories into a professional field where he hoped to help others in their struggles. He was intimately familiar with the challenges of the street, of bochurim who felt disenfranchised and unable to make the grade in typical yeshivos, of young people who thought life would be better on the other side of the rainbow, only to crash headlong into the quicksand of alcohol and substance abuse and other illicit behaviors until someone would be there with a rope to pull the lucky ones out.

And he knew he was one of the lucky ones. We’d originally met in his yeshivah, when he invited me to give a talk about spotting the signs of falling into addictions. He looked the regular black-and-white part, but later revealed that he’d worked hard to rehabilitate himself following a bout with alcohol and depression. The following year we met again, when he was the dorm counselor at a program that was something between a yeshivah and a rehab outside Jerusalem.

We’d been in touch a few times over the past year — once or twice to ask a question about the diagnosis and treatment of a tough kid he’d encountered during his training at a local therapeutic high school, and maybe a third time to meet up for a cup of coffee and just talk.

I was always happy to meet with Kalman. I’d known him for about four years now, and what a pleasure it was to watch him grow from the enthusiastic bochur into the responsible dorm counselor into the social work student who was thrilled to tell me he had gotten engaged to a fellow student.

“She’s great, Dr. Freedman,” he said, his smile shining through any formalities of our discussion. “She’s also from kind of a tough background like me — Monsey, not Lakewood — but she gets my story and what I’ve been through and she has her own story. But also like me, she wants to work to be the best possible therapist she can be.”

“Sounds fantastic, Kalman, mamash like you found your co-pilot for the journey,” I said as I gave him a big mazal tov hug. And I really meant it.

It’s great when young men like Kalman — who had grown up in an abusive home and fought through a drinking problem by the age of 18 — figure it out and get married. I certainly wished him much success. But I also imagined that wasn’t why he’d asked to meet.

But before I had too much time to think, Kalman jumped right in. “Dr. Freedman, I wanted to ask you a question because I was accepted to a very prestigious internship for this final year of my social work program. But here’s the thing: It’s great and prestigious and all, an internship at the biggest teaching hospital in Jerusalem in the inpatient psychiatric unit. But it’ll be a lot of work.”

Don’t I know it. It brought back some mildly traumatic memories of 100-hour weeks as an intern at Harvard Medical School. Days that started in the hospital at 5 a.m., davening Shacharis with sunrise in the call room before rounds began, 30-hour overnight shifts multiple times per week. I remembered the nights I slept in the hospital and the nights I didn’t get a wink of sleep in the hospital and remembered what it felt like to juggle four pagers on my belt while simultaneously putting on my tefillin in the psychiatric emergency room between seeing patients.

It wasn’t pleasant.

I couldn’t help but to laugh when Kalman told me of the 10-hour days and the monthly overnight shifts in the emergency room.

But I knew Kalman, and he wasn’t the type to be deflected by a little hard work, especially since he’d come so far already. He was struggling with something else — and it could be he didn’t even know it himself.

“Kalman,” I said, “I’m about to do my end-of-week shopping in the Machaneh Yehudah shuk now. How about joining me for a walk?”

As I paid for my olives and we moved across the street toward the bakery I liked to frequent, Kalman helped me stuff a dozen zaatar pitas into a bag before we moved onto the fruit stand where I filled a bag with cherries.

Maybe it was the noise, the shouting vendors, the unpretentious crowd of all stripes — either way, Kalman was working through his decision.

“You know, Dr. Freedman, they say it’s the best training, as you get to work with the local experts in a very intense treatment program. Doing my internship there, I’d really get a lot of high-quality experience and supervision. On top of that, there is extra training in CBT and motivational interviewing, which would really prepare me for my career helping with bochurim with addictions.”

I thought back to the time I was forced to pick between training programs well over a decade ago and told Kalman my own story. “There were two great options which had both bent over backwards to offer me a shomer Shabbos program, but one was known for being more of a laid-back experience, even as the hours and pay were better. The other was a notoriously intense experience with far more early mornings, overnight calls, and grueling responsibilities covering up to four different hospitals at a time.

“What to do? I sought out the most dedicated physician and best family man I knew: my Dad. We sat on the porch and discussed the pros and cons for a little while before he reframed the choice for me in a way I hadn’t previously thought about. ‘You can go ahead and do the easy program for sure,’ my Dad told me, ‘but at some point in the future when you’ll have to make a life-and-death medical decision, you’ll be glad you went through the tougher program, because it will help you save a life. And that’s why we’re doing this in the first place.’ ”

Kalman was quiet for a few moments and digested what I had said. “Dr. Freedman, I’ll be honest with you. You think I’ve never been in a hospital helping a friend detox? You think I haven’t been to the psych ward after a buddy’s suicide attempt? I was even there myself — and frankly, I’m in such a different place now, baruch Hashem, that I’m not sure I want to go back there, even on the other side.”

“Kalman,” I said, “I don’t doubt for a second that it will make you into a better therapist who’s going to be saving lives. You can help the next generation, but you gotta go back into the trenches.”

Kalman smiled. Were those tears in the corner of his eyes? But I knew he was about to make the right decision.

 

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

 

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in the Old City or hiking the hills outside of Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 820)

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